Laryngoscope design and the difficult adult tracheal intubation.

Clinical examination of a patient is very likely to reveal the factors making tracheal intubation difficult and thus increasing the likelihood of a traumatized temporo-mandibular joint or mouth. Although laryngoscopes and bronchoscopes incorporating fiberoptic visual devices are invaluable they are usually only employed for extremely difficult patients. Other laryngoscopes exist in a variety of designs and can be categorised according to the particular problem they address: (i) prominent sternal region, (ii) narrow space between the incisors, (iii) reduced intraoral space and, (iv) the anteriorly positioned larynx. An atraumatic tracheal intubation will be assisted if the laryngoscope blade to be used is selected on the basis of the anatomic difficulties prescribed by the patient. The Miller, Jackson-Wisconsin, Macintosh, Soper, Bizarri-Guffrida, and Bainton blades together with appropriate handles and fittings comprise a group from which selection can be made.